Acupuncture and Stroke

Why I Pay To Have Over 50 Needles Shoved in Me Every Week

It works.

I go to the gym, go to the pool, and go to acupuncture, all things I have to pay for, and all things that involve varying degrees of discomfort, because they are all working, demonstrably, to hasten my recovery from brain damage.

To get why they are having a positive effect, I think it helps to understand what's going on with me. When I had the strokes, bits of my brain died. The bits that died mostly controlled motor function: the movement of muscles. In some cases, like the left side of  my face, although sensation remained, I lost all the brain matter that was sent signals to move the muscles. In other cases I lost sensation and control, like in part of my right butt; it felt like I was sitting on something in my back pocket, but in fact I was just sitting on my ass, and couldn't feel it (I can now, no need to kick me). In most cases, I lost some of the brain matter controlling some of the muscle, with the result of making almost every part of my right side below the neck weaker and less coordinated. The secondary problem, in some cases, is that of atrophy: it's been a long time since some muscles saw use. My right hand is visibly thinner than my left, and there are muscles in my face that can only be felt on the right side.

At this point, some seventeen months after the strokes, to recover, I have to get other parts of my brain to do the jobs that the dead bits used to do. This is a process that is similar to a baby learning to use its body, a process that takes many years, and is eventually optimized in adolescence, which is why teenagers can be great klutzes, but suddenly graceful by their late teens. I'm hoping it doesn't take me as long as a decade, but it might.

Using the brain's plasticity to get live bits to do the work of dead can only happen when there is stimulus in the brain in the live bits. That's why function now improves slowly, and improvement only happens in muscles whose controlling brain parts were adjacent to living brain tissue. Their signals were reaching still-living brain matter, but it has to learn not to ignore the signals as irrelevant, and take responsibility for new muscle.

Gym work both requires muscles to work, and the brain to control them, more often than not in the stabilisation; that's why I do mostly dumbbell work. In the pool, I'm requiring muscular control and coordination, and also parenthetically working on my endurance which is pretty low. The benefits are clearly noticeable: despite being tired after swimming, I walk better. So, what does acupuncture do?

Here's what an acupuncture session is like, if you've never had one. You take off varying amounts of clothing, sometimes  lie face up, sometimes face down, and the acupuncturist puts a bunch of needles in you. Then you rest for a while, often falling asleep. Finally the acupuncturist removes all the needles and you're done. Yes, some of the needles hurt some of the time, but usually for no more than a second or two. Also, I've had a lumbar puncture (a.k.a. spinal tap), and these are nothing in comparison.

Often, you're booked in for an hour's session, and the acupuncturist will come and wake you up so they can get the needles out and get you dressed before their next client. I've been going to a great place called Olo Acupuncture in New York, that practices community acupuncture: the treatment happens in a communal space with a bunch of table and chairs to lie in. Apart from the price, the best thing for me is that they let you rest (or snooze) for as long as the treatment takes. On a recent trip, when one of the needles was damn sore, I slept for over two hours, and it's not like I'm running a sleep deficit.

There's a lot about traditional Chinese medicine that is alien to my skeptical self, and as a result I find it useful to think of much of the approach as having a very good, but rather peculiar, working metaphor. Frankly, I don't care if a practitioner is balancing my chi, clearing wind from my trembling limb, or just poking me with needles: it works. I feel better afterwards, more even, more symmetrical.

What about the placebo effect? Perhaps it's just me thinking that acupuncture is going to work, and so it does. For many of the benefits I perceive that could be the case, and the mind is certainly significant in changing the brain, but not all. The left side of my face has gradually been moving thanks to acupuncture. I have no doubt about it. Before I had needles in my face and left orbit, my left side did not visibly move. It does now.

What I think is going on is that the needles are stimulating the atrophied muscles, or nerves into those muscles, and my brain is recognising that stimulation as requiring response. Perhaps it's as simple as the needle being fine enough to be an irritant without causing damage. Perhaps it's something else: acupuncture anesthesia seems to work on a different principle. No matter, I can't stimulate those muscles any other way; believe me, I've tried.

In the end, what matters to me, is that acupuncture is helping me to recover, and to recover faster from the brain damage caused by stroke. It works.

Valentine Update

I'm combining this month's update with last week's goal report, both of which are late. Saturday and Sunday the snow kept me housebound: there was a lot of it, and it wasn't cleared enough for me to walk on without too great a risk to limbs, ass, and dignity. Not that I give much of a damn about my dignity any more. 

Monday, I thought it would be clear enough to go all of two blocks to pick up yet more drugs from Rite Aid. This thought was a mistaken one. The two blocks there and back were so wretched in the rain with uncleared sidewalks, half-block detours, near calamity and general precipitation induced misery that I gave up on the whole day and wrote it off. So three days of playing XCOM ensued. Not a complete loss, though, because I have discovered that console games improve my right hand's dexterity and sensitivity. Good thing, too, since XCOM is so damned good. 

Today, Tuesday, I was back at the gym, and stronger, if unsteadier. Before I went, I could hear the start of that siren call to indolence, but quashed it easily. I did wonder if that was how the depressive slump could start though: obsessive interest in something distracting, initially with a good reason, but soon disregarding the flimsy pretext for being sedentary. 

To the update:

Vision hasn't changed noticeably, but my left eye is coming closer to closing. There are signs of life in the lower lid, which seems to be closing at night. It doesn't blink so well, and it's a son of a bitch to get moving, but I'm certain it's attributable to acupuncture. No change in the oscillopsia yet, nor obvious change in the diplopia, but I'm seeing an ophthalmologist soon, so who knows what that may bring. It turns out the video of my one-and-a-half syndrome is still on tape on the neuro-ophthalmologist's desk, but when it's digitized, expect a link!

My left facial palsy is gradually lifting, again thanks to acupuncture. It's a bit weird having all those needles shoved in my face, but it's working. I still only smile with the right side of my mouth, but I'm confident that the left will join in soon.

Toiling away in the gym and pool has been improving my strength and endurance, but the right side weakness still exists. It's really noticeable doing something like a dumbbell chest press, where my left hand lifts the weight smoothly and cleanly, but the right hand wobbles and the arm begins to struggle sooner.

Balance has definitely improved, most clearly visibly at the gym, again, where I can now actually do standing dumbbell calf raises without falling over (mostly). I seem to be swaying backwards and forwards, though, even when I have a steadying point under my hand. This swaying explains a lot of the apparently random pitching forward and stepping back that I've been doing, but I'm currently at a loss to correct it. 

The period of the sway does not match the period of the tremor, which I think is improving, again thanks to acupuncture. One of the needles in particular hurt like hell in time with the impulse to twitch, so maybe the needles are reconditioning my arm not to move in a bad way. Who knows? I still slept for two hours solidly, pain or no pain, so the needles were doing something!

The exciting new discovery is that I'm slightly deaf in my left ear. Not enough for me to have noticed before now, but my snoozing alarm increases in volume, and I realized that I could hear it first through my right ear, even when it was closer to my left. It's not a huge deal, so I'm not worried about it, but it is consistent with the theory that I have some left side vestibular damage.

All in all, not too bad, considering that a year ago I was just starting to add some weight machines into my gym routine, and leaving my stick behind in the gym was pretty scary.

I should thank the anonymous benefactors who got me hand grip strengtheners and a pull-up bar from my Amazon wish list; I have used both and they are doing me good! I haven't figured out how to find out who was that kind from the interface, so they are anonymous pro tem.. 

Finally, here's the week's progress report. Three days off mean a big fail on most of the goals, but snowpocalypse and I saved humanity from an alien invasion, so I think I'm allowed.

Weight Goal: 170lb. Last week: 198lb, this week: 197lb.

Exercise Goal: gym 3-4x, swim 2-3x - This week: M:swim, T: day off!, W: Swim, Th: Upper, F: Swim, Sat/Sun: snow

Meditation: M, T, W, Th, F

Tai Chi: M, T, W, Th, F

Stretching Goal: after every gym - Th,

Writing Goal: write at least one word a day on Project #1: M: 42, T: 0, W: 68, Th: 46, F: 117

Timor Tremoris Conturbat Me

I am not bothered by the prospect of death at all; the fear of it doesn't happen to me, let alone disturb me as it did the medieval Catholic poets. I've seen death close up, my own and others, and I know that I'm doing what I can to defer my demise as long as possible. What does bother me, is the tremor and fear of it.

My right hand and arm is the most obvious place that the tremor occurs. I have what is called an intention tremor, which, if you look at the linked Wikipedia page, is "very difficult" to treat. So there's the fear that it will never go away, and I will always write terribly with a pen, always spill drinks with my right hand, and so on. I'm afraid that the brain damage's effects will be permanently with me.

The fear is more extensive though because the tremor--or at least something like it--is more extensive. To start with, my right leg shakes. This is similar to the sort of shaking that happens with muscle fatigue, and usually goes away when I press down on my right heel. My concern, though, is that the tremor extends to my leg as well, but that genuine muscle fatigue is masking it.

This isn't as crazy as it sounds, when you consider what is perhaps the scariest trembling that I have, which is in my diaphragm. My breath shudders as I inhale, as though I am taking a series of gasping breaths, instead of one smooth inhalation. I notice it when I'm meditating (it's a distraction!) but it's obvious to observers when I inhale involuntarily after sighing.

The fear that my breath will always be juddering is horrible, and I have to try to ignore it. It was terrifying to realize in November 2011 how damaged my voice was, and it's scary now to contemplate the possibility that I will never attain the vocal facility that I once had.

The most effective treatment seems to be acupuncture, so far. Nothing else has worked. So thanks to the donors who've made more needles possible! I'll talk about the needles soon, I promise. 

Annual Update #1

As is typical, this update is a few days late, so instead of marking exactly a year since I first had a stroke, this is closer to a year since I had the last stroke. For those keeping score, or just catching up, I started with a big old haemorrhage of the pons (that would be a burst, blood vessel in the brain stem), and then over the next few days had a bunch of ischaemic attacks all over my frontal lobes (those would be clots), the largest of which was in my right frontal lobe, the rest dotted about the place.

None of the tiny ones was transient (small enough to go away before causing cell death), also known as TIAs or mini-strokes. However, they were small enough that their effects are likely too small to be noticeable, once the swelling (caused by the damage) went down. The best guess any doctor has had since is that my strokes were caused by high blood pressure. This seems reasonable, since it turned out that my blood pressure was easily high enough to cause my brain to pop. I am not lying when I say the paramedic in the ambulance said he "didn't know it went that high." Whence, my first bit of wisdom:

1. Check your blood pressure. If it's consistently over 140/90 then see your doctor and badger her or him until you figure out why and get some medication. If you're not already, start getting fit and staying that way: It will take at least a year before you get the beneficial effects reaching your blood pressure, but the other benefits come sooner.

They don't call hypertension (high blood pressure) "the silent killer" for nothing. If you read on to the rest of my progress report, think for a minute about the odds of any given bit of blood vessel in the brain bursting, and how a millimeter or two either way would have stopped my heart. I forget the numbers, but many people who have haemorrhagic strokes just die on the spot, and 37.5% die within 30 days (I remember those numbers).

Statistically, making it to a year is good going, although I did not feel the danger, and still don't. Perhaps because it's too terrible to contemplate having another stroke (they really do suck), or because I have focused my energies on being alive for another 40 years (I had the stroke at 40), but I simply don't entertain the possibility of another traumatic brain injury. That  doesn't mean, however, that I am not aware that I had a lot of help surviving the first year. Heck, I had help surviving the first hour. There is a Buddhist virtue of having the humility to accept charity, and I have learned a lot about that virtue through experience over the last year. Part of what I have learned is that you should:

2. Be generous in life. On one level, purely selfishly, generosity is a sort of insurance: if you have been generous, then should you get screwed by fate or misfortune, that generosity returns to you many times over. More than that, though, generosity and the compassion that feeds it, is rewarding in and of itself, because by practicing it (in the sense of doing it repeatedly), we become better people: We can like ourselves more.

One of the trickiest things to deal with is the label disabled and what it means to me now, as well as what it meant before I had a stroke. It has thrown some of my prejudices into rather sharp relief, before stamping them out (mostly). So much of my energy and attention is spent on "getting better" that it can be hard to step back and say 'actually, I'm physically kind of fucked, and may be that way for good.' I try to be honest with myself in these posts, but it leads to a discontinuity of perception that when I think and say, for example, "my balance has improved," that means that I've noticed a tiny improvement, but I still walk like a wretched drunk.

While I would be the first to say that I have been very lucky to have no detectable cognitive deficits (my mind is still fine), and that I have been very lucky that I am able enough to work out at the gym, and not be chair-bound or worse, it sometimes makes it harder. If you saw me, for example, waiting to cross the street, from the right side, I would not be surprised if you saw a buff, able-bodied guy, and would forgive you for wondering why I have a walking stick. I find myself thinking I don't carry this damn thing for fun, you know a lot, often while resisting the temptation to compare the durability of a tibia with that of 3/4" of willow. So, wisdom (or plea) cometh:

3. Make room for the guy with a stick. If only to protect your shins. Just as you have no idea why someone else is lifting that weight, that way in the gym, you have no idea why someone else is carrying a walking stick and may not even be obviously using it. What matters is only your response, and trust me, I am grateful to anyone who accommodates me and my disability.

I realise this has all been rather general, and is in danger of sounding a bit "poor me, my life is so saaaaaad nowwwwww!" but if it come across as whiny, you'll just have to suck it up as though you were watching Star Wars, and trust that by and large, I do not feel sorry for myself. Life is too damn short for pity parties. To specifics:

Vision
I still have one and a half syndrome, so my left eye does not track all the way to the left, and my right eye has a nystagmus when tracking right. (You're online, look it up.) This is not particularly debilitating, because I also have double vision (diplopia), which is debilitating. To have only a single image, I have an occluding filter on the left eye, which is just basically a cloudy filter stuck to my glasses. This lets me function, where double vision did not, but being monocular has its own drawbacks: sidewalks all look flat, I'm bad at judging distance, I have no idea how fast vehicles are travelling towards me, and so on.

Being monocular makes walking harder, but it's probably not as bad as the final piece of my visual problems, which is oscillopsia. That's just what it sounds like: my eyeballs oscillate.  It's not as crazy and fun as Mad-Eye Moody (I now have an intimate understanding of why he's nuts), but it is difficult. Because life should not have simple problems, my left eye seems to oscillate horizontally, while my right oscillates vertically. Also it's sometimes better, sometimes worse.

This all means that I read slower, and I read less, which is a considerable blow. When the oscillation is very bad, or text is relatively small, or I'm in a hurry, I can't read text directly: If I concentrate on a sentence or word, my eye skitters about. Instead, I have to allow the sentence to form in my mind, and read the words from a short term memory of the image. It's hard to describe, and hard to do.

The neurologists and ophthalmologists reckon that it's 'very unlikely' or just 'impossible' for any of these visual conditions to improve. I think that's bollocks, because since they first told me that, I've had independent (i.e. I'm not delusional) verification that they have improved. One thing I am sure of is that, if I believed the experts on this, then there would be no possibility of improvement. Instead I have learned to:

4. Be patient and persistent. My vision is not going to fix magically overnight; the days when brain swelling might subside and sudden improvement occur are over. If it's going to improve, and I have to persist in the belief that it will, then it will take years to improve. Just as it may be years before the hip flexor stretching I'm doing will be really obviously beneficial, and just as it took months for the exercise I've done to pay off. For the important things, patience starts at weeks.

Facial Palsy
Probably the most obvious sign of my stroke is the left-side facial paralysis (or palsy). A year ago, it was as though I had had Botox injected in exactly half of my face. Over the last 12 months, it has improved substantially, but I still have an obvious droop which affects my speech and is, frankly, ugly. I have never considered myself a particularly handsome adult, but until now, I have never made someone scream in shock and terror. (She was a dumb teenager, it was funny.)

The palsy extends to my left eyelids, and is, I suppose, one of the factors screwing up my left oculo-motor muscles (as described above; I should be clear that my field of vision is fine, and I think my visual cortex is fine, if a little stressed). The paralysis of my lower left eyelid in particular means that my left eye does not close properly, ever, although it tears just fine and is thus wet enough. 

So far, acupuncture has been the only treatment that seems to have had a concrete effect on the facial palsy. Again it is slow, and I now have the problem that the relevant muscles are well and truly atrophied, as well as not yet controlled by my brain, but it is working. So,

5. Do what works. Take effectiveness over expert opinion every time, whether it's diet, gym. gaming or health, if something is working for you, keep doing it. The natural corollary is to keep looking for what works. I have done this now with Acupuncture (shout out to Olo Acupuncture!) and I've done it with games: I don't play with people I don't like, and I don't play games I think are garbage. Which doesn't mean I think that the people I don't like, or the games I think are garbage are invalid or wrong. I'm just not in any hurry to take pills that have only marginal efficacy.

Right-side weakness
While the facial palsy is obvious, the right-side damage is less so. My bicep and quadriceps are above average now, and my body fat is well below average, but I am far weaker than I used to be. Worse, my right side is far less coordinated, which contributes to my poor balance. I can't, for example, stand on my right leg alone for any length of time (although I keep practicing). So I look pretty good (the six-pack is starting to show), but I have to or I fall over.

All the strength training, stretching, swimming, tai chi, Pilates and now yoga are aimed at making my right side more effectively functional. Almost all of my right side below the neck seems to have been affected, from muscles that lost all motor control in the brain, and in some cases, sensory input as well, to muscles that are working at a percentage of what they were, because some of the controlling brain matter was lost.

In essence, I am trying to accelerate the process of the brain learning to use muscle, a process that happens over many years of infancy and childhood, and is not optimized until adolescence. Of course it is tricky to do buttons up with my right hand; it takes a child four or five years to acquire the dexterity to do that. Again, I have to be patient (which I have never, I think, been known for), and persist with everything that human beings do, and at the same time,

6. Pick battles carefully and consciously. I think it is not OK to pick up the slack of my right hand's clumsiness with my left; in only five or six weeks, I am better at handling the bunch of keys to my apartment. It's still slow, and I still sometimes drop them, but that is a battle I am fighting and winning. I chose to fight it, though, because I am 41, not 81, and it is worth regaining full use of my right hand, even if it takes years to do so. Be conscious about whether fighting a battle is worth your time.

I say it is worth fighting these battles, and maintain that it is, but I am aware, and frankly scared, of the possibility that the tasks I have set myself may be Sisyphean. I may never consolidate any of the gains I have made. While I walk better, to walk well, I must pay attention to walking, down to the level of the muscles and bones involved. I find myself wondering if the childhood reality we forget is filled with the very boring job of learning to use our bodies and minds, and the idea that children are living the best years of our lives is total bullshit.

Maybe it's just that sometimes, I just want to walk casually up a street, chatting to my friends, and I can't do that yet. It doesn't really matter, I am under no illusion that life is or should be easy, or that the universe owes me anything; it doesn't. That makes it all the more important, though, to:

7. Celebrate your victories. All of them, especially the little ones. Remember to observe your victoriousness over entropy when you set foot in the gym, finish a set, rack a weight, walk up the stairs, do your shopping, do your laundry, even write a long update. 

Tremor
I have an intention tremor in my right side that is most obvious in my right arm and hand when I spill fluid or drop cutlery. It makes handwriting very slow and difficult, typing tricky, and is more of a nuisance than you would expect from a 'minor' ailment. I think it's getting better, but I'm not certain, and it's binary like the diplopia: big or small, it's just as debilitating. I don't think about it much, because I can't do anything about it, so why worry?

Balance
When you see me walking, it's like I'm really blasted. There is no danger of me passing any balance-based sobriety test any time soon. I believe this is mostly due to the weakness and lack of motor control in my right side, but it may also be vestibular (in the ear), which will be harder to correct for. I think this is improving, I think the tai chi particularly, but also Pilates and yoga will help keep it improving, but for now the ataxia is why I walk with a stick, and I am quite likely to be very, very sober.

Blood Pressure
A year and a few days ago, when I had just had a blood vessel in my brain go 'pop,' my blood pressure was measured at 250/160. If you halve that figure, you get to roughly human normal for my age. It would also have been decreasing since the actual stroke. Now, my blood pressure is under 130/80 consistently, but that's thanks to no fewer than four medications. I take a couple more that are more generally related to having a stroke, but four are just to keep my hypertension in check.

Finally, after many months of exercise, my cardiovascular system is showing some signs of one of the desired effects: my blood pressure is starting to come down. I still have no explanation of why it was so damn high, except "shit happens" and "genetics," but I do have an optimistic expectation that I will be able to reduce some of the pharmacological load on my system. A load that might have been substantially lower if I had understood that I had to:

8. Get fit and stay fit. Or die. In most cases, die younger, in more discomfort, and with greater indignity. Exercise correlates with a happier, longer life. Start now. Every time you choose to defer getting fit or losing weight if you need to, you are choosing to die sooner, and it is not worth it if you ask me. You may decide that being fat, or unfit, or smoking or binge drinking is worth doing, even if it cuts decades off your life, but make that decision consciously, and be aware that you are choosing pleasure now at the cost of years later. It's your choice to make, but I have lived side-by-side with people who had avoidable strokes, and had a largely avoidable stroke myself, and I would rather go to the gym.

That's it for the anniversary update. I may not have made it clear, but I welcome any questions you have. The anniversary party was good fun (even though I only had one mimsy bottle of beer)!

August Update

Oops, the 10-month update is a bit late, but I promise there's no cause for alarm! Instead, with the prospect of the next update coming from back home in Queens, things are good, all things considered. Of course when "all things" includes brain damage, the devil is in the details.

Generally, I'm doing well; my Dad, stepmom and sister have been away for a few weeks, which has given me more of an opportunity to do things for myself that were once routine, but are no longer. It turns out, for example, that a tremor does not help with egg-beating, so I shan't be making chocolate souffle until I have some motor control back. Similarly, heavy shopping isheavy! And fresh fruit and veg are not light.

Even with my newly-invigorated drive to eat well, I get caught out by supermarket trickery, not sadly limited to the "2 for £3" variety either. I've been buying granola at the local health food shop, but when I saw Sainsbury's (a big chain here) own-brand kilo bag was half the price, I didn't think twice. How bad can granola be? It turns out that, relatively speaking, very bad. It may be half the price, but somehow they have managed to triple the amount of saturated fat, make it lots sweeter, and disappear the nuts. I'll be going back to the more expensive granola that won't give me diabetes, thanks.

Many things are still much slower than they were, and its been especially noticeable in the kitchen. I've avoided finding the whole process depressing by caring far less about some ingredients. Finely chopped onion? This is as fine as its getting until I can hold my knife hand still. I should cook smarter and prepare meals to eat tonight and reheat tomorrow, but I end up eating quite a lot, so that hasn't happened much. I'm also slowly losing weight, while eating what feels like a ton, which tells you perhaps how much exercise I'm getting.

Acupuncture continues to make me feel better, and is the major contributor to the improvements in my face. The paralysis thing anyway; the needles can't make me beautiful! I can feel, and just about see more muscle activity in my left face, so while it will be obvious I had a palsy for some time, I'm confident that eventually my phizog will be back to parity. I chatted with someone who'd had a stroke four years ago at 42, who had no obvious sign of the palsy he had once had, but it was soon obvious that his was due to brain swelling interrupting the nerve, rather than my case where the nerve is OK, but routes to tissue that is dead.

There's every sign that living brain tissue is taking over though, everywhere I've been affected. I'll have definitive proof that my double vision is improving when I go back for another eye exam. Either I'll need less of a prism, or I'm delusional. Unfortunately, the double vision is a binary kind of thing, like the tremor. They are both improving, but while they exist at all they make life interesting. I am a little tired of sidewalks appearing flat when they are not.

I think at this point, my brain is working to adapt itself to having a bit missing. At the same time as its putting in place new pathways to activate muscles from my right little toe to my neck, it still sends expectant impulses to brain matter that isn't there any more. I can know that I'm leaning to the right, and fully expect the neuro-muscular bit of me that learned to deal with that lean at the age of one+, but unless I do something consciously about it,  I will soon be on the floor.

Eventually, I won't have to think about it at all, but walking, for example, is still far from automatic. It's certainly smoother and faster, but I have to pay attention. Sadly this means I meander when walking and talking. Stagger would probably be more accurate. I do not chew gum.

All of which means its worth it going to the gym as much as I have been; it's been worth stretching for up to an hour six days a week. Going to Pilates class has been good for me, so has the ab workout, so has doing some Tai Chi every day. All of these things have made me work muscles in ways that they're supposed to be able to work, hard as that is sometimes, and as a consequence laid down neural paths that I will be reinforcing and one day optimizing for years to come. Getting quite buff at the same time doesn't suck, either.

Ye Shiwen, Acupuncture and Racism

I've been seeing an acupuncturist for a couple of months now, and I am in no doubt at all that it has been beneficial. I would not otherwise spring for weekly visits. Most of the benefits have been nebulous in terms of scientific data--they could all come from the haphazard results of neurological activity.

The same cannot be said about the improvement I have felt in my paralyzed face. It will inevitably take time for the feeble muscular motion that I can feel to be easily visible, since the relevant muscles have had nearly ten months off to atrophy, but unless I'm delusional, I can tie that progress directly to acupuncture.

When you realize how little is honestly understood about neurology, and that we are only just getting scanning machinery capable of tying new theories of pain to anaesthetic acupuncture, then you have to ask why acupuncture has so long been pooh-poohed by western medicine.

The question can be rephrased: given that western medicine knows very little about how the nervous system really works, why is the evidence of a technique that has been successful for several thousand years dismissed?

The only answer that I can come up with is that most of the successes were on Chinese people, and most of the practitioners were Chinese. In other words, fundamental racism.

While I was pondering the question and the inevitability of the answer, Ye Shiwen swam her amazing and inspiring races, and had her achievement sullied by the coach of Team USA, who did all but actually accuse Ye of doping.

It's worth pointing out that Ye is at the age when great leaps in performance can happen, that she has never tested positive for doping, that China's swimmers are not all doing extraordinarily well this Olympics, that Ye was less than four years old when China was doping its swim team. and that the American swim team, excellent as many of them are, is not nearly as representative of US demographics as, say, their women's gymnastics team.

Which leaves the dirtiness of racism sullying the US team. Shame.

41st Birthday

I'm 41 today, and it's 7 months and 7 days since I had a big old stroke, so time for an update.

Vision: I had an eye test, and my eyeballs are basically the same as they ever were, which is good: there's no visual field loss or anything. I think they're slowly improving, in that the double vision seems to be gradually correcting, but boy is it slow. It will be interesting to see how well I handle the prescription swimming goggles, since at the moment with regular goggles I just let my eyes do whatever they do, as myopic as ever. My reading speed has improved, too, although it will take binocular vision to get back to where it was.

Balance and Walking: clear improvement. When I last did one of these monthly(ish) updates, I was just recovering some motor control of part of my right leg. Now the formerly missing bits of calf, quad and glute are back for sure. My right leg still sometimes declines to hold me, apparently at random, and I keep my stick handy when I go out, but I walk around the house without the stick. I've also been going to Tai Chi class, and while it is scientifically impossible to correlate any improvement in my balance with my daily Tai Chi practice, my practice has improved in that time, and so has my balance, which is evidence enough for me to keep at it.

Left Facial Palsy: I finally got to see the local speech and language therapist, who had done a bunch of homework by the second time I saw her, and had a load more exercises to try out. As a result there are tiny signs of improvement, and I feel less crazy when I can sense muscles trying to engage with no visible result. Although I'm supposed to do them in a mirror, it's pretty depressing to see nothing happen for weeks on end, so I often just do them blind, paying close attention to the sensations I feel. I suspect I'll have a lop-sided grin for quite a while.

Right Side: although my right side is clearly getting stronger, and it's been very useful to do exercises that isolate each side in the gym (i.e. dumbbell exercises have been more useful than barbells or machines, and form reigns supreme) I've developed or exposed a problem. My right hand and arm now have a tremor that is at least superficially similar to what you'd see in someone with Parkinson's. This means that while I should use my right hand as much as possible, so that I don't allow the left to compensate instead of forcing recovery, I don't want to use it if that means reinforcing the 'bad wiring' that's caused the tremor.

On the positive, however, acupuncture today (yes, I spent time on my birthday being treated to steel needles) was positive, seems to have reduced the tremor, and has left me feeling less asymmetrical. My sample size of one is sufficient for me, when I am that one.

I said to the acupuncturist that recovering from a stroke will either teach you patience or drive you mad. Last night, at Tai Chi, I was able to squat as low as the bulk of my legs would let me -- ass to ground -- and without falling over. It's taken me three months of persistent stretching, exercise, and an occasionally bruised ass to get there. There are many things left for me to do in life, but I am patient.